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Low serum and bone vitamin K status in patients with longstanding Crohn's disease: another pathogenetic factor of osteoporosis in Crohn's disease?

Abstract

BACKGROUND

A high prevalence of osteoporosis is reported in Crohn's disease. The pathogenesis is not completely understood but is probably multifactorial. Longstanding Crohn's disease is associated with a deficiency of fat soluble vitamins, among them vitamin K. Vitamin K is a cofactor in the carboxylation of osteocalcin, a protein essential for calcium binding to bone. A high level of circulating uncarboxylated osteocalcin is a sensitive marker of vitamin K deficiency.

AIMS

To determine serum and bone vitamin K status in patients with Crohn's disease and to elucidate its relationship with bone mineral density.

METHODS

Bone mineral density was measured in 32 patients with longstanding Crohn's disease and small bowel involvement, currently in remission, and receiving less than 5 mg of prednisolone daily. Serum levels of vitamins D and K, triglycerides, and total immunoreactive osteocalcin, as well as uncarboxylated osteocalcin ("free" osteocalcin) were determined. The hydroxyapatite binding capacity of osteocalcin was calculated. Data were compared with an age and sex matched control population.

RESULTS

Serum vitamin K levels of CD patients were significantly decreased compared with normal controls (p<0.01). "Free" osteocalcin was higher and hydroxyapatite binding capacity of circulating osteocalcin was lower than in matched controls (p<0.05 and p<0.001, respectively), indicating a low bone vitamin K status in Crohn's disease. In patients, an inverse correlation was found between "free" osteocalcin and lumbar spine bone mineral density (r=-0.375, p<0.05) and between "free" osteocalcin and the z score of the lumbar spine (r=-0.381, p<0.05). Multiple linear regression analysis showed that "free" osteocalcin was an independent risk factor for low bone mineral density of the lumbar spine whereas serum vitamin D was not.

CONCLUSIONS

The finding that a poor vitamin K status is associated with low bone mineral density in longstanding Crohn's disease may have implications for the prevention and treatment of osteoporosis in this disorder.

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  • Authors+Show Affiliations

    ,

    Department of Gastroenterology and Hepatology, University Hospital Maastricht, Maastricht, the Netherlands. ESCH@sint.azm.nl

    , , , ,

    Source

    Gut 48:4 2001 Apr pg 473-7

    MeSH

    Absorptiometry, Photon
    Adult
    Analysis of Variance
    Body Mass Index
    Bone Density
    Case-Control Studies
    Chromatography, High Pressure Liquid
    Crohn Disease
    Durapatite
    Female
    Humans
    Linear Models
    Male
    Osteocalcin
    Osteoporosis
    Risk Factors
    Statistics, Nonparametric
    Triglycerides
    Vitamin D
    Vitamin K Deficiency

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    11247890

    Citation

    Schoon, E J., et al. "Low Serum and Bone Vitamin K Status in Patients With Longstanding Crohn's Disease: Another Pathogenetic Factor of Osteoporosis in Crohn's Disease?" Gut, vol. 48, no. 4, 2001, pp. 473-7.
    Schoon EJ, Müller MC, Vermeer C, et al. Low serum and bone vitamin K status in patients with longstanding Crohn's disease: another pathogenetic factor of osteoporosis in Crohn's disease? Gut. 2001;48(4):473-7.
    Schoon, E. J., Müller, M. C., Vermeer, C., Schurgers, L. J., Brummer, R. J., & Stockbrügger, R. W. (2001). Low serum and bone vitamin K status in patients with longstanding Crohn's disease: another pathogenetic factor of osteoporosis in Crohn's disease? Gut, 48(4), pp. 473-7.
    Schoon EJ, et al. Low Serum and Bone Vitamin K Status in Patients With Longstanding Crohn's Disease: Another Pathogenetic Factor of Osteoporosis in Crohn's Disease. Gut. 2001;48(4):473-7. PubMed PMID: 11247890.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Low serum and bone vitamin K status in patients with longstanding Crohn's disease: another pathogenetic factor of osteoporosis in Crohn's disease? AU - Schoon,E J, AU - Müller,M C, AU - Vermeer,C, AU - Schurgers,L J, AU - Brummer,R J, AU - Stockbrügger,R W, PY - 2001/3/15/pubmed PY - 2001/4/21/medline PY - 2001/3/15/entrez SP - 473 EP - 7 JF - Gut JO - Gut VL - 48 IS - 4 N2 - BACKGROUND: A high prevalence of osteoporosis is reported in Crohn's disease. The pathogenesis is not completely understood but is probably multifactorial. Longstanding Crohn's disease is associated with a deficiency of fat soluble vitamins, among them vitamin K. Vitamin K is a cofactor in the carboxylation of osteocalcin, a protein essential for calcium binding to bone. A high level of circulating uncarboxylated osteocalcin is a sensitive marker of vitamin K deficiency. AIMS: To determine serum and bone vitamin K status in patients with Crohn's disease and to elucidate its relationship with bone mineral density. METHODS: Bone mineral density was measured in 32 patients with longstanding Crohn's disease and small bowel involvement, currently in remission, and receiving less than 5 mg of prednisolone daily. Serum levels of vitamins D and K, triglycerides, and total immunoreactive osteocalcin, as well as uncarboxylated osteocalcin ("free" osteocalcin) were determined. The hydroxyapatite binding capacity of osteocalcin was calculated. Data were compared with an age and sex matched control population. RESULTS: Serum vitamin K levels of CD patients were significantly decreased compared with normal controls (p<0.01). "Free" osteocalcin was higher and hydroxyapatite binding capacity of circulating osteocalcin was lower than in matched controls (p<0.05 and p<0.001, respectively), indicating a low bone vitamin K status in Crohn's disease. In patients, an inverse correlation was found between "free" osteocalcin and lumbar spine bone mineral density (r=-0.375, p<0.05) and between "free" osteocalcin and the z score of the lumbar spine (r=-0.381, p<0.05). Multiple linear regression analysis showed that "free" osteocalcin was an independent risk factor for low bone mineral density of the lumbar spine whereas serum vitamin D was not. CONCLUSIONS: The finding that a poor vitamin K status is associated with low bone mineral density in longstanding Crohn's disease may have implications for the prevention and treatment of osteoporosis in this disorder. SN - 0017-5749 UR - https://www.unboundmedicine.com/medline/citation/11247890/full_citation L2 - http://gut.bmj.com/cgi/pmidlookup?view=long&amp;pmid=11247890 DB - PRIME DP - Unbound Medicine ER -